title: A policy of dedicated follow-up improves the rate of removal of retrievable inferior Vena Cava Filters in trauma patients.
abstract: Retrievable Inferior Vena Cava Filters (IVCF) for prophylaxis against pulmonary embolus have been associated with low rates of removal. Strategies for improving the rates of retrieval have not been described. We hypothesized that a policy of dedicated follow-up would achieve a higher rate of filter removal. Trauma and Nontrauma patients who had a retrievable IVCF placed during 2006 were identified. A protocol existed for trauma patients with chart stickers, arm bracelets, and dedicated follow-up by nurse practitioners from three trauma teams. No protocol existed for nontrauma patients. Statistical analysis was performed using χ(2) analysis or analysis of variance. One hundred sixty-seven retrievable IVCFs were placed over 12 months; 91 in trauma patients and 76 in nontrauma patients. Trauma patients were more likely to have their IVCF removed than nontrauma patients, 55 per cent versus 19 per cent, P < 0.001. There were differences between the three trauma teams, with removal rates of 44 per cent, 42 per cent, and 86 per cent respectively (P < 0.05). On multivariate analysis young age and trauma patient status were independent predictors of filter removal. A policy of dedicated follow-up of patients with IVCFs can achieve significantly higher rates of filter removal than have been previously reported. Similar policies should be adopted by all centers placing retrievable IVCFs to maximize retrieval rates.
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona 85724-5063, USA. tokeeffe@surgery.arizona.edu
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Joby J
authors.initials: JJ
authors.lastname: Thekkumel
authors.forename: Susan
authors.initials: S
authors.lastname: Friese
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.forename: Shellie C
authors.initials: SC
authors.lastname: Josephs
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D020878:Device Removal / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000601:surgery